Quiz 1- Ch 6 Flashcards
What factors affect motivation and adherence?
1) locus of control
2) Self efficacy
3) Self esteem
4) Social Determinants of health
What is locus of control?
1) internal locus of control- believe they can influence what will happen to them
- -tend to be self motivated and follow suggested treatment protocols because they can make difference in their lives
- -more health oriented
2) external locus of control- believe that what happens to them is a result of outside influences or events
- -tend to be less adherent to treatment protocols because they believe their efforts will not make a difference
- Locus of control and switch between internal and external- not always one or the other, it’s fluid
- Illicit adherence: need to explore client’s beliefs about the benefits of the proposed therapy
What is self efficacy?
- Client’s perception of reality
- sense of competence adn ability that is related to how successful people believe they can be in accomplishing a task
- avoid tasks if cant adequately participate or complete it
- others believe ultimately succeed if they continue their efforts even if they are having difficulty
- Self judge their abilities- not always accurate
- Dynamic concept- therefore it can be changed
How do individuals with poor self efficacy act?
- if in difficult situation misjudge their abilites, become angry and frustrated and lose focus on task
- believe things are more difficult then they really are
How do individuals with strong sense of self efficacy act?
- see difficult situation as more of a challenge, causing them to try harder
- better able to cope following disability or illness
How to develop adherence according to self efficacy?
- client must believe they can complete the task (self efficacy) and the task will benefit them (outcome expectation)
- introduce clients to other clients with similar diagnosis who have succeed in recovery
- establish short term goals that are very achievable
What is self esteem?
How individuals feel about themselves
How does self esteem affect adherence?
low self esteem decreases client’s motivation to participate in treatment
What are social determinants of health?
- Race/ethnicity,
- literacy
- education
- income
- place of residence
Where does change occur?
where people live- home, work and school, but not all places have infrastructure needed to modify lifestyle
How do social determinants of health impact adherence?
- clients have to be willing and ABLE make the desired changes
- role of community and family impact decision making
What are two subgroups of social determinants listed in the book?
Community resources
Social support
How do community resources impact motivation?
Community resources are outside medical encounters and really help change poor habits
- clinicians often lack knowledge of community resources and therefore don’t make referrals
- Just providing support and information isn’t always sufficient for change
How does social support impact adherence?
- more support is better adherence
- more support more satisfied they are with care, resulting in greater adherence
- social factors influence health behaviors: social enviros at home, work, and health care system support or impede health behaviors
- greater caregiver stress = less adherence
- if have spouse, often greater chance of adherence
How do we increase adherence via social support?
- know about community programs and how to get a client connected
- inform patients about community programs
- Information empowers clients which is a strong motivator
What are barriers to adherence?
- lack of finances, transportation, and social support
- lack of ability- manifested as pain, fatigue, and feeling overwhelmed
- Secondary gain
- secondary loss
- emotional distress (anger, anxiety, depression)
- psychopathology
- somatization, symptom magnification and malingering
- comprehension
- mental status
- Identifying barriers is a by-product of good communication, work to mitigate once they are discovered
What is the health belief model?
utilizes psychological theories of decision making to determine what actions individuals might choose when presented with various health care choices
How does the health belief model describe adherence?
- health behaviors and choices are influenced by the value people place on a potential outcome and their belief that a certain course of action would result in that desired outcome
- must be ready to make a change
- health related behavior depends on value placed on their health
- believe have control = greater adherence
- believe don’t have control = less adherence
- impacted by people’s perceptions of their health status
- if believe barriers are too great to over come then people less likely to change
- need to believe value of change is stronger than consequences of not making the change
How do you motivate patients using the health belief model?
- clients’ beliefs must align with our view that western medicine provides appropriate solutions
- need to find out client beliefs so they can be discussed and form the basis of collaborative plane of care
What are the 5 A’s of Behavioral Intervention Protocol?
1) address the issue
2) assess the clients
3) advise the clients
4) assist the clients to make change
5) arrange for follow up
What does it meant to address the issue?
- make sure we have the client’s attention and that we are fully attentive
- name the problem and present the need for intervention
What does it mean to assess the clients
- determine where they are in the stages of changes, and barriers preventing them from engaging in more healthful behaviors
- ask what they want to change and how they plan to implement change
- determine if previous attempts to change behavior
What does it mean to advise the clients?
- use medical role and provide information and educate patient on reasons change is needed
- help clients understand benefits of change and consequences of not changing
What does it mean to assist the clients?
where we negotiate an agreeable plan of care
What does it mean to arrange for follow up?
Schedule other appointments to review progress, address barriers, and renegotiate the protocol
Describe goals that are important to clients’ lives
Tend to be: -functional -meaningful -motivating relevant goals that they help set often increases clients commitment
What type of goals to clients successfully reach?
- specific
- challenging
- achievable
- have the opportunity to successfully practice the skill
- don’t want them too high or too low
What are things to keep in mind when setting goals?
- review goals, revise as needed
- incorporate patient’s goals in plan of care
- develop their ideas into measurable and attainable goals
- goals can be set to maintain or slow the rate of decline
- educate on short term and long term goals; and show them the link between the two
What can you have the client do increase goal adherence?
- have them write out their goals in their own words
- use a calendar or journal, help them establish realistic timelines
- have clients sign personal contracts stating they will adhere to treatment plans
How should providers and clients collaborate?
- provide opportunities for clients to make real choices in treatment goals and planning–> stimulates clients to use own skills and resources to achieve outcomes
- client satisfaction positively correlated with degree of client involvement
- providers need to consider client’s previous history and incorporate into treatment
What are barriers to collaboration?
Client's: -disabilites -nonadherence lack of interest in collaboration -Provider's failure to take client's premorbid lifestyle and history into account except for in a very superficial way-->can lead to discovering motivating factors to develop an effective treatment plan
What are the barriers perceived by clients?
- Provider’s lack of time
- uncertainty that treatment goals would be helpful
- inadequate knowledge about how to collaborate in treatment planning
